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This is VAERS ID 1125507

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1125507
VAERS Form:2
Age:65.0
Sex:Female
Location:Illinois
Vaccinated:2021-02-12
Onset:2021-03-17
Submitted:0000-00-00
Entered:2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 AR / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Anxiety, Asthma, GERD
Allergies: Avelox, influenza vaccine, sulfa, tetracycline
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Death within 60 days of vaccination


Changed on 5/7/2021

VAERS ID: 1125507 Before After
VAERS Form:2
Age:65.0
Sex:Female
Location:Illinois
Vaccinated:2021-02-12
Onset:2021-03-17
Submitted:0000-00-00
Entered:2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 AR / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Anxiety, Asthma, GERD
Allergies: Avelox, influenza vaccine, sulfa, tetracycline tetracycline
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Death within 60 days of vaccination

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1125507&WAYBACKHISTORY=ON


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